Chronic limb ischemia

Pain

Intermittent claudicating		Rest pain
Site		Site	Foot and toes
Distal arterial disease	Foot
Superficial femoral artery	calf
Aortoiliac disease	Gluteal region Thigh calf
Onset	insidiously	Onset
Course		Course
Duration		Duration
Severity	Claudication distance	Severity	Patients spend the night sitting in chair in attempt to relieve pain
Character	Cramp-like	Character	Continuous aching
Radiation		Radiation
Referral		Referral
Relieving factors	Rest	Relieving factors	Strong analgesics
Exacerbating factors	Exercise	Exacerbating factors	Night Elevation of the leg Warmth
Relation to other symptoms		Relation to other symptoms	Tissue loss
Cause	Muscular ischemia	Cause	Nerve ischemia

Tissue changes and loss

Trophic changes (Loss of skin appendages – Loss of subcutaneous fat – Muscle wasting – Bone osteoporotic)
Ulceration or Gangrene

Symptoms of atherosclerosis elsewhere
Brain (TIAs – Stroke)
Heart (Angina pectoris – MI)
Kidney (Hypertension – Haematuria) Intestine (Postprandial angina)

Possible cause

Predisposing factors of atherosclerosis

Cigarette smoking – Hyperlipidaemia – Hypertension – Diabetes mellitus – Obesity – Physical inactivity – Diet high in saturated fats – Hyperhomocysteinaemia – Raised Lp(a) lipoprotein concentrations – Hypercoagulable states

Factors suggesting Burger’s disease

Male – Between 20-40 years – No risk factors of atherosclerosis – Smoking